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Depression and osteoporosis: epidemiology and potential mediating pathways

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Abstract

Introduction

There have been numerous studies examining the association between depression and bone mineral density (BMD), but the underlying nature of this relationship remains unclear. Independent of this association, there is a growing body of evidence that depression impacts the risk for fracture in older adults. This article reviews the current epidemiological evidence regarding comorbidity of depression, low bone mineral density, and fracture.

Methods

A review of the literature on depression, depressive symptoms, low BMD, osteoporosis, and fracture using electronic databases.

Results

We reviewed 20 studies of the association between depression and BMD and five reports of the relationship between depression and fractures. Potential mediating mechanisms (both physiological and behavioral) are discussed, as well as potential confounding influences (e.g., medication use).

Conclusions

Most studies support the finding that depression is associated with increased risk for both low BMD and fractures, but variation in study design, sample composition, and exposure measurement make comparisons across studies difficult. Researchers should be aware of potential confounders, such as medication use, that may influence results. Future research should focus on identifying mediating pathways and targets for intervention in the relationships between depression, low BMD, and fracture.

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Acknowledgements

This work was supported by National Institute of Mental Health grants T32-MH14592, R01-MH47447 and F31-MH78443.

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Authors and Affiliations

  1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Suite 886, Baltimore, MD, 21205, USA

    B. Mezuk & W. W. Eaton

  2. Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, 624 N. Broadway Suite 886, Baltimore, MD, 21205, USA

    S. H. Golden

  3. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway Suite 886, Baltimore, MD, 21205, USA

    S. H. Golden

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  1. B. Mezuk
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  2. W. W. Eaton
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  3. S. H. Golden
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Correspondence to B. Mezuk.

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This article reviews evidence regarding comorbidity of depression, low bone mineral density, and fracture, and potential mediating and confounding influences. Most studies report that depression is associated with an increased risk of osteoporosis and fractures. Potential mediating pathways include physiological and behavioral changes, comorbid medical conditions and medication use.

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Mezuk, B., Eaton, W.W. & Golden, S.H. Depression and osteoporosis: epidemiology and potential mediating pathways. Osteoporos Int 19, 1–12 (2008). https://doi.org/10.1007/s00198-007-0449-2

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